The Medicare System and Senior Citizens

Medicare benefits are, inevitably, something we must all become familiar with as we get closer to retirement age. However, what exactly is medicare? When did it begin? And what is its purpose? Here is a brief outline of the federal government’s medicare program, including its history and the rationale for its existence. Medicare came into existence in 1965. It was created as one of the component parts of then-President Lyndon B. Johnson’s “Great Society” initiative. The principal purpose of medicare was to provide a system of healthcare for elderly U.S. citizens, i.e. individuals who were sixty-five years of age or older. However, medicare benefits are not simply for the elderly. Medicare is also availabe to individuals who are younger than sixty-five and who are disabled.

Qualifying for medicaid benefits on the basis of disability status, of course, requires that a person file an application, or initial claim, for title II benefits with the social security administration. Title II benefits are mandated under title 2 of the social security act and title II benefits are commonly referred to as social security disability benefits, or SSD.

Individuals who are approved for social security disability benefits are eligible to receive medicare benefits two years after their date of entitlement has been established and, no doubt, this provides for a healthcare safety net for disabled citizens who must subsist on a relatively small monthly disability benefit.

Who is eligible for medicare? Fortunately, unlike supplemental security income and medicaid benefits, medicare is not considered a needs-based program. In other words, younger individuals who are disabled and individuals who are of retirement-age may be eligible without regard to their income.

Until recently, medicare benefit coverage was thought of primarily in terms of hospital insurance and medical insurance. Medicare part A covers hospital visits and nursing home stays, while medicare part B pays for outpatient care and services, including doctor’s visits, xrays, and lab reports. However, the medicare program was recently restructured to include a prescription drug benefit. This is known as medicare part D.

Medicare part D went into effect on January 1st, 2006, as part of the Medicare, Prescription Drug Improvement and Modernization Act. Medicare Part D is available to any individual who is eligible to receive medicare part A and medicare part B benefits. The intent of medicare part D is to guarantee prescription drug coverage for medicare beneficiaries. However, the federal government does not actually provide this coverage. Prescription drug coverage under medicare part D is provided by independent drug plans that are actually operated by private health insurers, though, legally, such plans are regulated by the federal government, i.e. the medicare program.

Are medicare benefits free? No, medicare part B requires the payment of a monthly premium which, for 2006, was $88.50. However, for those individuals who might have difficulty paying this premium, an assistance program is available to qualified individuals to pay part B premiums. This program is known as MQB, or medicaid for qualified (medicare) beneficiaries. Like other types of medicaid, this particular medicaid program is needs-based and serves no other purpose than to pay a medicare recipient’s monthly medicare insurance premium.

The Medicare program may well be the most transformational program to arise as a result of Lyndon Johnson’s Great Society initiative, and its effect, in many ways, may be as profound as the creation of the social security program under President Franklin D. Roosevelt. Recent estimates hold that medicare accounts for more than a tenth of all federal spending and approximately one-third of healthcare spending.

The author of this article is Tim Moore, who, in addition to being a former food stamp caseworker, medicaid caseworker and AFDC caseworker, is a former disability claims examiner. He publishes a blog on the disability process which is titled the Social Security Disability and SSI blog

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